Source:Bryce J, Boschi-Pinto C, Shibuya K, et al and WHO Child Health Epidemiology Reference Group. WHO estimates of causes of death in children.
Lancet.
2005
;
365
:
1147
–1152.

Researchers with the World Health Organization’s (WHO) Child Health Epidemiology Reference Group report on an effort to improve the accuracy of methods used to determine estimates for the causes of death in the world’s children from 2000–2003. Six causes accounted for 73% of the 10.6 million yearly deaths in children younger than 5 years of age: pneumonia (19%), diarrhea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The 4 communicable disease categories accounted for more than half of all deaths. Measles accounted for another 4% and HIV/AIDS for 3%. Undernutrition represented an underlying cause in 53% of all deaths among children younger than 5 years old. Worldwide, 42% of deaths occurred in the WHO Africa region and 29% occurred in the Southeast Asia region. Ninety-four percent of global malaria deaths and 89% of global HIV/AIDS deaths occurred in the Africa region.

These researchers claim that these estimates represent a new degree of methodological rigor and transparency in the development of epidemiological estimates on mortality, and they call for expanded efforts to strengthen child health epidemiology. The authors recommend that these new estimates of the causes of child deaths be used to guide public- health policies and programs, and they call for renewed efforts to prevent and control pneumonia, diarrhea, and undernutrition worldwide, and malaria in Africa.

Dr. Dubik has disclosed no financial relationships relevant to this commentary.

Before 2004, the WHO,1 UNICEF,2 World Bank,3 and the United Nations Population Division4 estimated the cause-specific mortality of children younger than 5 years independently, producing different figures. This paper is an example of the improved collaboration and standardization that is needed for proper evidence-based public health decision-making.

This study attributes nearly half (49%) of deaths under 5 years of age to largely preventable causes: pneumonia, diarrhea, malaria, and measles. Malnutrition, also preventable, is also noted to be a major underlying cause of childhood deaths. In an accompanying editorial, the writers “take a step back and look for the most important single determinant of childhood death – which has to be poverty”5 and note that an Ethiopian child is 30 times more likely than a western European to die before his or her fifth birthday.2 This improved counting provides an opportunity to identify the contributors to childhood mortality worldwide. It will hopefully lead to a better chance that each child really will count.

This report provides a potent argument for the strengthening and expansion of immunization programs to prevent both measles and pneumococcal pneumonia. Another study in this same issue of Lancet demonstrated that a 9-valent pneumococcal conjugate vaccine was highly efficacious in decreasing radiologically documented pneumonia and invasive pneumococcal disease in Gambia.6 The economic challenge of providing new generation conjugate vaccines to children in the developing world...

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